Provider Demographics
NPI:1669006987
Name:ADAMS, CASSIDY EMI (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:EMI
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SANTA BARBARA AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4471
Mailing Address - Country:US
Mailing Address - Phone:626-233-9514
Mailing Address - Fax:
Practice Address - Street 1:889 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1736
Practice Address - Country:US
Practice Address - Phone:805-456-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst